HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA Trial)

Löffler, Thorsten; Rossion, Inga; Brückner, Thomas; Diener, Markus K.; Koch, Moritz; Frankenberg, Moritz von; Pochhammer, Julius; Thomusch, Oliver; Kijak, Thomas; Simon, Thomas; Mihaljevic, André L.; Krüger, Matthias; Stein, Erwin; Prechtl, Gerald; Hodina, René; Michal, Walter; Strunk, Roland; Henkel, Karl; Bunse, Jörg; Jaschke, Gregor; Politt, Dirk; Heistermann, H. P.; Fuer, Mathis; Lange, Claas; Stamm, Achim; Vosschulte, Andreas; Holzer, Ralf; Partecke, Lars Ivo; Burdzik, E; Hug, Hubert M.; Luntz, Steffen; Kieser, Meinhard; Büchler, Markus W.; Weitz, Jürgen

doi:10.1097/sla.0b013e318272df97

Cited by 73 publications

(94 citation statements)

References 18 publications

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“…To date, it remains unclear which technique should be preferred. Recently, one large multicenter randomized trial was published with a non-significant trend toward fewer obstructions by stapling [3]. There was no difference regarding complications while stapling resulted in a shorter operation time.…”

Section: Introductionmentioning

confidence: 93%

Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials

Löffler

Rossion

Gooßen

et al. 2014

Langenbecks Arch Surg

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Section: Introductionmentioning

confidence: 93%

Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials

Löffler

Rossion

Gooßen

et al. 2014

Langenbecks Arch Surg

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“…The surgical technique employed for the ileal anastomosis has been widely studied, and various published randomized controlled trials (RCTs) compare handsewn vs stapled anastomoses [10,11] . In our study, when analyzing the surgical technique and related complications, we only found statistical significance between end-to-end anastomosis without resection and postoperative paralytic ileus.…”

Section: Discussionmentioning

confidence: 99%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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AIM:To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS:A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS:The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION:Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Protective ileostomy; Stomas; Stoma-related complications; Surgical infections; Colorectal surgery Core tip: Protective ileostomies are widely used by surgeons for the protection of anastomoses, but they imply a second intervention for reversal. Despite being considered a minor intervention, ileostomy reversal does not lack complications. Adjuvant treatment, complications from the first intervention, or low-priority consideration can delay the closure of the stoma. In our study, we reviewed all complications following ileostomy reversal and found they were considerably high (40%), and increased as did the time (in months) until closure (P = 0.041). In multivariate analysis, male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003).Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 Available from:

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“…Ileus and bowel obstruction are still a major concern after ileostomy closure, and studies on technical issues have been carried out to address the problem. Some published randomized controlled trials compared stapled with hand-sewn anastomosis [23,24] . From our results, stapled anastomosis was more frequently used in the standard group, which may have increased the total cost for this group (standard group, 33,564 ± 10,448 CNY vs. late group, 29,233 ± 10,661 CNY; p = 0.03).…”

Section: Discussionmentioning

confidence: 99%

Advantages of Early Preventive Ileostomy Closure after Total Mesorectal Excision Surgery for Rectal Cancer: An Institutional Retrospective Study of 123 Consecutive Patients

et al. 2016

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Background/Aim: Preventive ileostomy is frequently constructed to minimizethe consequences of anastomotic leakage after resection of rectal cancer. There is no consensus regarding the best timing for temporary stoma closure after proctectomy for rectal cancer. This retrospective study sought to determine whether the timing of stoma closure influenced postoperative outcomes. Methods: Subjects were 123 patients with rectal cancer undergoing laparoscopic or open total mesorectal excision surgery with preventive ileostomy from 2012 to 2015. They were divided into 2 groups according the timing of stoma closure: the standard group who had closure within 90 (60-120) days (n = 78) and the late group who had closure after 180 (150-210) days (n = 45). Results: There was no significant difference in operative time, operative blood loss or postoperative complications between the 2 groups. Timing of postoperative fasting and length of hospital stay was similar in both groups. Adjuvant chemotherapy was not a risk factor for postoperative complications after stoma closure. Conclusions: There was no significant difference between different timings of temporary stoma closure in relation to postoperative complications. Delayed stoma closure showed no benefit in prevention of morbidity. Early closure is safe and can provide better quality of life for patients.

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HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA Trial)

Abstract: Hand-sewn anastomosis versus stapler ileo-ileostomy for ileostomy closure are equally effective in terms of postoperative bowel obstruction, with stapler anastomosis leading to a shorter operation time. Postoperative ileus after ileostomy reversal remains a relevant complication.

Cited by 73 publications

References 18 publications

Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials

Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Advantages of Early Preventive Ileostomy Closure after Total Mesorectal Excision Surgery for Rectal Cancer: An Institutional Retrospective Study of 123 Consecutive Patients

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